As I advance in age, I am exposed more and more to the health care industry, despite having enjoyed relatively good health until recently. As a retired New York State employee, I am blessed with excellent health insurance that covers most doctor visits, medical tests and procedures, as well as prescription drugs, with only a relatively modest co-pay. Here are a few observations:

First, it appears that many of our health problems are what a friend of mine calls “diseases of affluence.” More appropriately, they should be called “diseases of lifestyle,” since they affect people of all socioeconomic strata. A lot of these are directly influenced by government policies. For instance, our auto-centric physical infrastructure minimizes the opportunities for and pleasures of walking and cycling, and cannot help but contribute to obesity and other problems based on lack of physical activity. Our government subsidies to cane sugar and corn (the main ingredient of high fructose corn syrup) help make junk food and sugared soft drinks attractively priced. This is especially so for the poor, since the SNAP program (formerly known as Food Stamps) allows their purchase with SNAP benefits. If we collectively spent more on complete streets that were friendly to pedestrians and cyclists, as well as cars, how much could we save on health care (not to mention on school transportation)? How about if we stopped subsidizing sugar? I think it would be worth a try.

For all the criticism leveled against it, the Affordable Care Act (“Obamacare”) has achieved something great — it has shifted the dialog from whether health care insurance should be extended to many of those who don’t have it to how the present system should be replaced or improved. Neither Trump nor his minions are suggesting that those who obtained health insurance through Obamacare should lose it, meaning that they recognize that there is no going back on government’s commitment to growing numbers of its citizens. Whether things actually get better or worse remains to be seen, but at least no one is talking a bout a pre-Obamacare “reset.” To me, that is yuge.

A cyclist breaks a wheel on a potholed street in a major city near the State’s capital.

A lawyer goes to the State Library to conduct legal research, only to find that several of the treatises he consulted had not been updated for several years, rendering them virtually useless. The other public access law library in Albany is open only three days a week.

A person living in a city, two miles from the Capitol,wants to go to downtown Albany by public transit. She will have to walk a half mile to the nearest bus stop, and even during rush hour, she may wait up to half an hour for a bus. It may be quicker to walk, except in the winter, when the walkways on the bridges over the railroad tracks are not cleared and become icy.

Compared to what I saw in Sweden this summer, our public sphere is definitely third world. I think we have a right to demand — and government has an obligation to provide — basic services of decent quality. If it can’t, we need to find out why and correct the problem, and it may not be as simple as throwing more money at it.

Even the relatively affluent cannot escape bad roads, traffic delays and, in some cases, poor public schools. While some of the Republicans’ ideas have some validity, I absolutely disagree with their disagreement with the Obama and Warren observations that no one’s success is due to solely to his or her own efforts. We all benefit from public services. Why such an affluent country puts up with such poor services is beyond me.